Title X funding for reproductive health care could lapse due to Trump admin delays
For health clinics that rely on federal funding through Title X, April 1 is one of the most important days of the year: It’s when annual grant program funds are typically renewed.
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The clinics rely on money to provide reproductive health services – such as birth control, cancer screenings, health screenings and HIV testing – to more than 2.8 million people, many of whom are low-income, uninsured or underinsured.
But this year, the Trump administration delayed the standard process for applying for new grants. So clinics across the country are worried the money they need won’t be available Wednesday.
Typically, the federal government opens the application process for Title X grants in the fall and gives clinics months to submit their applications. Instead, the Department of Health and Human Services began accepting applications on March 13 and gave clinics only a week to submit them.
Clinics had to use their awards from last year by Tuesday, but they can seek government permission to roll over the remaining funds.
“I’ve never seen such a short turnaround time between the application deadline and the funding deadline,” said Clare Coleman, CEO of the National Family Planning and Reproductive Health Association, an advocacy group for Title X clinics.
Coleman said she was not aware of any clinics receiving its annual award as of Tuesday afternoon.
“Typically, the government takes between 70 and 90 days to review applications,” she said.
Andrew Nixon, an HHS spokesman, did not respond to a question about whether Title X funds would be distributed on time Wednesday and instead sent a statement about the grant application process for next year.
“HHS, through the Office of the Assistant Secretary for Health, will issue new Notices of Funding Opportunity (NOFO) for FY 2027 for the Title X program consistent with agency priorities,” the release said.
Coleman said HHS has the option of telling clinics it will reimburse any expenses incurred during the waiting period before funding arrives. However, this has not yet happened. Nixon did not respond to a question about whether the agency would offer refunds.
The Title X program was passed in 1970, under President Richard Nixon, with bipartisan support. By making contraception accessible to families, regardless of their income, the program aimed to reduce unwanted pregnancies. It has expanded to include fertility services, breast and cervical cancer screenings and testing, and treatment for sexually transmitted infections.
Clinics offer services on a sliding scale based on family size and income. Families earning 100% or less of the federal poverty level — about $33,000 for a household of four — qualify for free care. Federal law prohibits clinics that take funding from denying care to patients who cannot afford it.
Brian Haile, CEO of the Neighborhood Health network in the Nashville, Tennessee, area, said he was working on contingency plans for his 12 clinics, assuming new funds would not arrive this week.
“What we’re trying to figure out is how much we can dip into our savings account to pay in hopes of getting reimbursed,” Haile said.
Neighborhood Health largely serves people of color and those living below the poverty line. Demand for Title X services has increased this year, Haile said, since rising insurance premiums prompted some people to drop out of Affordable Care Act plans.
If Neighborhood Health has to make temporary cuts due to a lack of operating funds, Haile said, it could force staff salaries to be reduced or clinics could start charging patients small amounts for insulin, which is typically provided at no cost.
If that happens, he said, “April 1 will be a really cruel April Fool’s joke.”
Other clinics are optimistic they will be able to maintain services as usual in the short term if funding is delayed.
Ruth Richardson, president and CEO of Planned Parenthood North Central States — which operates clinics in Iowa, Minnesota, Nebraska, North Dakota and South Dakota — said the organization plans to keep costs low or zero for Title X services for as long as possible.
“We would continue to honor the Title
Before Title A coalition of Democratic governors followed up on a letter last week emphasizing the importance of meeting the April 1 deadline.
Disruptions to Title X funding are not new, however. Last year, the Trump administration temporarily suspended funding for nearly a quarter of Title X grants for about 842,000 patients. HHS reinstated the grants in December, about eight months after the National Family Planning and Reproductive Health Association sued it to challenge the funding freeze. The group voluntarily dismissed the complaint in January.
President Donald Trump’s 2026 budget request proposed cutting the entire $286 million earmarked for the Title X program, but Congress included it in the funding bill passed this year.
“These are all essential health services that people need,” Richardson said. “It is far more cost-effective to proactively invest in the Title X program than to pay the cost of downstream consequences.”
HHS awarded grants over five years in 2022 to support more than 4,000 clinics, which are entering their final year of the grant cycle. Title X recipients are still required to reapply for funding each year.
During Trump’s first term, his administration banned Title X clinics from providing abortion care or abortion referrals, prompting about 1,000 clinics to leave the program. The regulations were rolled back under the Biden administration, and the current Trump administration has not revisited the restrictions.
“The Title X program, at least over the last decade, has been politically targeted in many ways,” Coleman said. “It has not received an increase in its annual funding from Congress for 11 consecutive fiscal years. Members of Congress have repeatedly attempted to eliminate the program altogether.”
Nonetheless, she said, “the program survives, and we believe it will continue to survive.”
